Youssef Mervat A M, Ahmed Ebtisam Shawky, Kamal Dalia Tarik, Elsayh Khalid I, Abdelfattah Mai A, Mahran Hyam Hassan, Embaby Mostafa M
Children Hospital, Hematology Unit, Faculty of Medicine, Assiut University, Assiut, Egypt.
Clinical Pathology Department-Faculty of Medicine-New Valley University.
Mediterr J Hematol Infect Dis. 2024 Mar 1;16(1):e2024034. doi: 10.4084/MJHID.2024.034. eCollection 2024.
Viral infections can cause direct and indirect damage to hematopoietic stem cells. The objectives of this study were to identify the frequency and severity of aplastic anemia in children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as recognize the response to treatment.
13 children with newly diagnosed severe aplastic anemia were enrolled in this prospective clinical trial. Blood samples were obtained from all patients to detect SARS-CoV-2 antibodies, and nasopharyngeal swabs were collected for reverse-transcription Polymerase Chain Reaction to detect SARS-CoV-2 viruses. According to the laboratory results, patients were classified as having SARS-CoV-2 positive antibodies and SARS-CoV-2 negative antibodies. Both groups received combined cyclosporine (CsA) + Eltrombopag (E-PAG). The hematological response, either complete response (CR) or partial response (PR), no response (NR), and overall response (OR) rates of combined E-PAG + CsA treatment after 6 months were evaluated.
Four children were recognized to have aplastic anemia and SARS-CoV-2 positive antibodies. Two patients fulfilled the hematological criteria for CR and no longer required transfusion of packed red blood cells (PRBCs) or platelets, and one had PR and was still PRBC transfusion-dependent but no longer required platelet transfusion. The remaining patient showed NR, and he had died before reaching the top of the HSCT waiting list. Moreover, six patients in the SARS-CoV-2 negative antibodies group had CR, while three patients had PR. The difference in ANC, Hg, and platelet counts between both groups was not significant.
The SARS-CoV-2 virus is added to several viral infections known to be implicated in the pathogenesis of aplastic anemia. Studies are needed to establish a definitive association and determine whether the response of bone marrow failure to standard therapy differs from that of idiopathic cases.
病毒感染可对造血干细胞造成直接和间接损害。本研究的目的是确定感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的儿童再生障碍性贫血的发生率和严重程度，并了解其对治疗的反应。
13例新诊断的严重再生障碍性贫血患儿参加了这项前瞻性临床试验。采集所有患者的血样以检测SARS-CoV-2抗体，并收集鼻咽拭子进行逆转录聚合酶链反应以检测SARS-CoV-2病毒。根据实验室结果，将患者分为SARS-CoV-2抗体阳性和SARS-CoV-2抗体阴性两组。两组均接受环孢素（CsA）+艾曲泊帕（E-PAG）联合治疗。评估6个月后E-PAG+CsA联合治疗的血液学反应，包括完全缓解（CR）或部分缓解（PR）、无反应（NR）和总缓解（OR）率。
4名儿童被确诊患有再生障碍性贫血且SARS-CoV-2抗体阳性。2例患者达到CR的血液学标准，不再需要输注红细胞悬液（PRBCs）或血小板，1例为PR，仍依赖PRBC输血但不再需要血小板输血。其余患者显示NR，在进入造血干细胞移植等待名单前列之前死亡。此外，SARS-CoV-2抗体阴性组的6例患者达到CR，3例患者为PR。两组之间中性粒细胞计数、血红蛋白（Hg）和血小板计数的差异不显著。
SARS-CoV-2病毒被添加到已知与再生障碍性贫血发病机制有关的几种病毒感染中。需要开展研究以建立明确的关联，并确定骨髓衰竭对标准治疗的反应是否与特发性病例不同。
